Midland's cardiac arrest survival rate almost double national average

Ruth CampbellMidland Reporter-Telegram

Published 7:00 pm, Sunday, July 12, 2009

Despite a Medicare study showing national rates of 18 percent survival in cases of cardiac arrest after getting CPR, Midland Memorial Hospital has a discharge rate of 31.6 percent averaged out from May 2008-April 2009, clinicians said.

Lynn Cooknell, cardiovascular care coordinator with the Heart Institute at MMH, and Intensive Care Unit Nurse Manager Julie Green said mechanisms are in place to try and ensure people make it home after any kind of arrest.

A Code 4 team, made up of an emergency room doctor, ER nurse, intensive care nurse and a respiratory therapist respond any time a patient, visitor or family member is unresponsive or has a heart irregularity.

Green gets Code 4 documentation and critiques, which are reviewed by a committee of the same name.

If a patient meets certain criteria, the hospital can use its hypothermia protocol after cardiac arrest. "It decreases the negative effects associated with lack of blood supply to the brain," Cooknell said.

Green said it also helps the heart not to work as hard. She noted the protocol, developed by open-heart surgeons about 50 years ago, is "very labor intensive" and requires one-on-one nursing care in ICU. Normally, the ratio is two nurses to one patient.

The patient is sedated, placed on a ventilator and packed in ice. Green said there are devices used to lower body temperature such as body wraps or IVs. The cooling must be complete in from two to four hours.

After 18 hours, the patient is slowly warmed up, but the amount of time it takes depends on the patient and how stable they are. "We have seen fabulous results with it - people leaving the hospital who years ago would not have left. They're going home as normal as when they came in. That's really rewarding for the staff involved," Cooknell said.

Green said the number of patients who undergo this treatment runs in cycles. But all medical staff who deal with cardiac arrest have been trained in it. Staff worked closely with Green, ER Dr. Larry Wilson, Dr. Gerardo Catalasan, Dr. Michael Miller, an emergency department educator and an ICU educator to develop the procedure.

Usually, new ideas come from things staff has read or seen.

"It's important that we keep up with the latest that's out there so we know to do the very best for our patients. It's a team effort. It has to be," Cooknell said.

Another contributing factor to MMH's success is its Clinical Assessment Team, headed by a critical care nurse, respiratory therapist and house supervisor. This squad is called in to assess a patient outside the ICU or Critical Care Unit when something "isn't right," Green said.

The CAT team evaluates the patient and decides what to do. "We've done a lot of training with staff both on the floor and ICU and CCU because they're the primary responders," Green said. "When they do intervene, they know what to look for. A lot of times it's low-blood sugar, but they want an extra set of eyes" to determine whether the patient should be kept on their floor, or moved to ICU or CCU.

Cooknell said medical personnel try to intervene before a patient suffers cardiac arrest, but being able to solve the problem depends on what is causing it. Green said it could be a pulmonary embolism or electrocution, which may not be fixable.

According to a large national Medicare study published in the July 2 edition of the New England Journal of Medicine and reported by The Associated Press, the odds of surviving cardiac arrest after getting CPR in a hospital are slim and have not improved in more than 10 years. Only about 18 percent of these patients live long enough to leave the hospital, AP reported.

Led by Dr. William Ehlenbach of the University of Washington at Seattle, the study analyzed the care of 433,985 Medicare patients treated from 1992-2005 around the country. Survival odds did not change much over time, it was found. Blacks had survival rates about one-quarter lower than whites. Men, older patients, and people admitted from nursing homes also had lower survival rates after CPR, according to AP.

Cooknell said the downturn in the economy is also going to have an impact because people are waiting longer to get treatment if they are ill.

"Patients are so much sicker than they used to be," Green said, adding aging Baby Boomers are contributing to the health care burden.